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The association between drought and outpatient visits for respiratory diseases in four northwest cities of China

DOI:10.1007/s10584-021-03152-7
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Bo Wang
Bo Wang
Bo Wang
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Shunxia Wang
Shunxia Wang
Shunxia Wang
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Lanyu Li
Lanyu Li
Lanyu Li
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Shenggang Xu
Shenggang Xu
Shenggang Xu
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Abstract and Figures

Drought is a devastating natural hazard that significantly affects human health and social and economic activities. This study aims to explore the short-term association between drought and outpatient visits for respiratory diseases (RDs) in four northwest cities, China. In this study, we obtained daily outpatient visits for RDs, meteorological factors, and air pollutant data in four cities (Lanzhou from 2014 to 2016, Wuwei from 2016 to 2018, Tianshui and Zhangye from 2015 to 2018) of northwest China. We used the daily Standardized Precipitation Index (SPI) as an indicator of drought and estimated the effects of drought on outpatient visits with RDs by using a generalized additive model (GAM) in each city, controlling for daily temperature, time trends, and other confounding factors. The city-specific estimates were pooled by random-effects meta-analysis. There were 1,134,577 RDs cases in the hospitals across the four cities. We found that a 1-unit decrease in daily exposure to SPI-1 was positively associated with daily outpatient visits for RDs, with estimated RR of 1.0230 (95% CIs: 1.0096, 1.0366). Compared to non-drought periods, the RR of daily outpatient visits for RDs for exposure to all drought conditions was 1.0431 (95% CIs: 1.0309, 1.0555). In subgroup analysis, the estimated effects of drought on outpatient visits for RDs appeared larger for males than females though not statistically different, and the estimated effects in children and adolescents were the greatest among different age groups. Drought likely increases the risk of respiratory diseases, particularly among children and adolescents. We highlight that public health adaptations to drought such as drought monitoring, mitigation measures, and adaptation strategies are necessary.
Drought characterization for Tianshui (from 2015 to 2018), Lanzhou (from 2014 to 2016), Wuwei (from 2016 to 2018), and Zhangye (from 2015 to 2018) in the northwest of China. Blue lines represent days with no drought conditions, and red represents days with drought conditions. Moreover, the more negative the SPI-1 values, the greater the severity of the drought conditions. SPI-1 showed the weekly value.
Drought characterization for Tianshui (from 2015 to 2018), Lanzhou (from 2014 to 2016), Wuwei (from 2016 to 2018), and Zhangye (from 2015 to 2018) in the northwest of China. Blue lines represent days with no drought conditions, and red represents days with drought conditions. Moreover, the more negative the SPI-1 values, the greater the severity of the drought conditions. SPI-1 showed the weekly value.
… 
Associations between drought and the daily outpatient visits for respiratory diseases in four northwest cities of China. The effect of SPI-1 is estimated as a relative risk (RR) and 95% confidence intervals (CI) to represent the risk of daily outpatient visits for respiratory diseases associated with a 1-unit decrease in exposure to SPI-1.
Associations between drought and the daily outpatient visits for respiratory diseases in four northwest cities of China. The effect of SPI-1 is estimated as a relative risk (RR) and 95% confidence intervals (CI) to represent the risk of daily outpatient visits for respiratory diseases associated with a 1-unit decrease in exposure to SPI-1.
… 
The overall relative risks (RR) of daily outpatient visits for respiratory diseases associated with exposure to all drought conditions and exposure by the severity of drought from light to very severe in comparison to exposure to non-drought periods. The RRs and their 95% confidence intervals (CIs) are combined estimates pooled across four cities using meta-analysis.
The overall relative risks (RR) of daily outpatient visits for respiratory diseases associated with exposure to all drought conditions and exposure by the severity of drought from light to very severe in comparison to exposure to non-drought periods. The RRs and their 95% confidence intervals (CIs) are combined estimates pooled across four cities using meta-analysis.
… 
The effects of drought on the daily outpatient visits for respiratory diseases in Tianshui, stratified by gender and age. The effects of SPI-1 are estimated as relative risks (RR) and 95% confidence intervals (CIs) to represent the risk of daily outpatient visits for respiratory diseases associated with a 1-unit decrease in exposure to SPI-1. The effects of all drought conditions are estimated as RR and 95% CIs to represent the risk of daily outpatient visits for respiratory diseases associated with exposure to all drought conditions in comparison to the non-drought periods. *The difference between children and adolescents (≤18 years) and adults (19~64 years) was significant at α=0.05.
The effects of drought on the daily outpatient visits for respiratory diseases in Tianshui, stratified by gender and age. The effects of SPI-1 are estimated as relative risks (RR) and 95% confidence intervals (CIs) to represent the risk of daily outpatient visits for respiratory diseases associated with a 1-unit decrease in exposure to SPI-1. The effects of all drought conditions are estimated as RR and 95% CIs to represent the risk of daily outpatient visits for respiratory diseases associated with exposure to all drought conditions in comparison to the non-drought periods. *The difference between children and adolescents (≤18 years) and adults (19~64 years) was significant at α=0.05.
… 
The relative risks (RR) of daily outpatient visits for respiratory diseases during all drought conditions compared to non-drought periods by changing the threshold of drought defined by SPI-1. Threshold 1 indicates that drought is defined as SPI-1 value falls below 0. Threshold 2 indicates that drought is defined as SPI-1 value is less than −0.5. Threshold 3 indicates that drought is defined as SPI-1 value is less than −1.0.
The relative risks (RR) of daily outpatient visits for respiratory diseases during all drought conditions compared to non-drought periods by changing the threshold of drought defined by SPI-1. Threshold 1 indicates that drought is defined as SPI-1 value falls below 0. Threshold 2 indicates that drought is defined as SPI-1 value is less than −0.5. Threshold 3 indicates that drought is defined as SPI-1 value is less than −1.0.
… 
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The association between drought and outpatient visits
for respiratory diseases in four northwest cities of China
Bo Wang
1
&Shunxia Wang
2
&Lanyu Li
1
&Shenggang Xu
3
&Chengyun Li
4
&Sheng Li
5
&
Jinyu Wang
6
&Hupeng He
7
&Jingping Niu
1
&Kai Zhang
8
&Bin Luo
1,9,10
Received: 31 December 2020 /Accepted: 18 June 2021/
#The Author(s), under exclusive licence to Springer Nature B.V. 2021
Abstract
Drought is a devastating natural hazard that significantly affects human health and social
and economic activities. This study aims to explore the short-term association between
drought and outpatient visits for respiratory diseases (RDs) in four northwest cities,
China. In this study, we obtained daily outpatient visits for RDs, meteorological factors,
and air pollutant data in four cities (Lanzhou from 2014 to 2016, Wuwei from 2016 to
2018, Tianshui and Zhangye from 2015 to 2018) of northwest China. We used the daily
Standardized Precipitation Index (SPI) as an indicator of drought and estimated the effects
of drought on outpatient visits with RDs by using a generalized additive model (GAM) in
each city, controlling for daily temperature, time trends, and other confounding factors.
The city-specific estimates were pooled by random-effects meta-analysis. There were
1,134,577 RDs cases in the hospitals across the four cities. We found that a 1-unit
decrease in daily exposure to SPI-1 was positively associated with daily outpatient visits
for RDs, with estimated RR of 1.0230 (95% CIs: 1.0096, 1.0366). Compared to non-
drought periods, the RR of daily outpatient visits for RDs for exposure to all drought
conditions was 1.0431 (95% CIs: 1.0309, 1.0555). In subgroup analysis, the estimated
effects of drought on outpatient visits for RDs appeared larger for males than females
though not statistically different, and the estimated effects in children and adolescents
were the greatest among different age groups. Drought likely increases the risk of
respiratory diseases, particularly among children and adolescents. We highlight that
public health adaptations to drought such as drought monitoring, mitigation measures,
and adaptation strategies are necessary.
Keywords Drought .Respiratory diseases .Standardized Precipitation Index
Climatic Change (2021) 167:2
https://doi.org/10.1007/s10584-021-03152-7
Bo Wang and Shunxia Wang are contributed equally to this work.
*Bin Luo
luob@lzu.edu.cn
Extended author information available on the last page of the article
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
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